Pain medicine : the official journal of the American Academy of Pain Medicine
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To identify and categorize anatomical anomalies of the vertebral artery and determine the relationship of these unexpected variations to the site for cervical transforaminal epidural steroid injections (CTESI). ⋯ CTESI have become a mainstay in the treatment algorithm for painful cervical radiculopathy. Described techniques take extreme care to avoid cannulation of the vertebral artery during this procedure. Unexpected deviation of the artery, or an arterial segment, into the posterior neural foramen, the target zone for CTESI, increases the risk of intraarterial cannulation during injection. Accordingly, the practitioner must be aware of variant anatomy of the vertebral artery and take all precautions to avoid potential complications that may arise as a consequence.
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Peripheral nerve injury can result in the formation of neuroma/nerve entrapment, a persistent peripheral neuropathic pain state which is often refractory to invasive interventions or medications. Therefore, there is a need in the field of pain management to develop innovative noninvasive therapy in treating post-traumatic peripheral neuropathic pain states. A new intervention, transcutaneous magnetic stimulation (tMS), is derived from the use of transcranial magnetic stimulation in which a rapid discharge of electric current is converted into dynamic magnetic flux for modulating neuronal functions. ⋯ tMS offers a noninvasive treatment option for neuroma-related neuropathic pain conditions. Randomized controlled studies are required in further validating the efficacy of this treatment modality. Additional studies are also needed to assess the underlying electrophysiological mechanisms of the observed analgesic benefit.